Government involvement and governance
The concept for the DNRC had its genesis in the desire to create a 21st century replacement for the Ministry of Defence (MoD) rehabilitation facility at Headley Court and engagement with government therefore naturally began with the MoD. In the very earliest stages of development of the concept however, the then Secretary of State for Defence recognized that there was also a significant opportunity to do something for the Nation as a whole, through the creation of a Defence and National Rehabilitation Centre on the same site.
From the outset therefore and, as the project has progressed, government involvement has increasingly extended beyond the MoD to other government departments and interested parties, notably:
Dame Carol Black, Expert Advisor to the Department of Health and the author of the influential 2008 report ‘Working for a Healthier Tomorrow’, reflects on the wider benefits to government, to the economy and to society as a whole that the creation of the National facility will bring.
- Department of Health (DH) and the NHS
- Department for Work and Pensions (DWP)
- Department for Culture, Media and Sport (DCMS)
- The Universities sector
Department of Health and the NHS
The involvement of the DH and the NHS, working with the MoD, is particularly significant. The starting points for this are threefold and worth noting:
- A concordat between the DH and Defence Medical Services (DMS) signed in 2005 set out to look at ‘ways in which the NHS and DMS can further develop their co-operation, for the benefit of all patients, whether military or civilian’.
- The establishment of a DH/MoD Partnership Board, co-chaired by the Surgeon General and the Director General of Social Care, Local Government and Care Partnerships at the DH, provides a forum for this co-operation and co-ordination to take place.
- The Armed Forces Covenant reinforces the government’s commitment to ensuring that veterans are not disadvantaged in accessing healthcare from the NHS by virtue of their having served in the military.
Close co-operation between DMS, the DH and NHS England throughout the DNRC project has allowed considerable mutual benefit to be achieved in all areas. NHS providers across the Midlands have also been involved in conceptualizing the model for the National facility.
Department for Work and Pensions
The DWP’s involvement has centred around vocational rehabilitation and enabling people to remain in, or return to work and extends both to veterans and to suitably highly motivated, working-age civilians.
Department for Culture, Media and Sport
DCMS involvement lies in the fields of disability sport and, in conjunction with the universities and Loughborough in particular, Sports and Exercise Medicine. Sport plays a significant part in the rehabilitation services to be provided at the DNRC and specific provision for this has been made in the form of a range of sports pitches and a pitch and putt golf course.
The Universities Sector
The universities in the Midlands have been involved in developing the concept for the National facility alongside the NHS Providers, but with particular focus on the opportunities for creating a national centre of excellence at the DNRC in both research and development and training and education terms.
For large, complex projects such as the DNRC, the way in which the governance structure is set up is fundamental to their success. The mandate to create the DNRC is from government to the Charity through the successive Written Ministerial Statements. In governance terms therefore, this is unusual in that the DNRC will be delivered by the charity, working in conjunction with government, rather than the other way round.
The DNRC Programme is directed by the Programme Director, General Sir Timothy Granville-Chapman.
Accountable to the Board of Trustees of the charity and chaired by the Programme Director, a DNRC Strategy Board (DSB) has been established to provide strategic and policy guidance, endorse investment decisions, provide definition of direction and ensure overall alignment. Each of the government departments and sectors involved is represented at senior (3 and 4 star) level.
Beneath this, the project structure established for the creation of the Defence establishment has two distinct components:
- The construction project to build the facility, delivered by the charity
- The business change project to relocate to the DNRC, delivered by the MoD
Accountability for the delivery of the MoD business change project is to the MoD, through a Programme Board established for the purpose.
For the National facility, a workstream accountable to the DSB has been established with a Steering Group to direct and oversee the work it undertakes. As with the DSB, each of the government departments and sectors involved is represented.
Following the WMS in July 2014 and consultation with the NHS Trusts and universities in the Midlands in December 2014, a governance structure was put in place with the objective of establishing a set of starting points for the 2016 business case.
A Steering Group and 3 Working Groups (WGs) covering the clinical, training and education and research and development domains have been established. The Steering Group includes representation from 4 government departments (Defence, Health, Work and Pensions and Culture, Media and Sport), NHS England and from the healthcare and universities sectors in the Midlands. Its remit is to support the development of the business case and, through the WGs, the development of models for a regional clinical centre and national centres for training and research.